Jane Brody, long time science writer for the NYT and bestselling author, recently published a 2-part critique of the use of dietary supplements. While the article raised some good points such as the use of diagnostics to detect nutrient deficiencies and the importance of alerting your doctor to your supplement use to mitigate the risk of deleterious drug-nutrient interactions, the overall tenor of the article ran counter to the sensible advice to use quality dietary supplements to support health.
I would like to directly respond to a few serious faults in her analysis, focusing on the second of her two reports. On multivitamins: “If you are a healthy adult with no known nutrient deficiencies, save your money.” Where do I begin on this ill-considered recommendation? According to research findings cited by healthypeople.gov, by the validated measure of self-assessed health, in 2007 only 9.5% of US individuals considered their health to be fair or poor (https://www.healthypeople.gov/2020/about/foundation-health-measures/General-Health-Status ). In that case, I suppose many people would take Ms. Brody’s advice to mean that a multivitamin is not for them. However, the same healthypeople.gov article noted that nearly half of US adults over the age of 18 had at least one of the following conditions: cardiovascular disease, arthritis, diabetes, asthma, cancer, or chronic obstructive pulmonary disease (COPD). I might add about a third of US adults are obese, a condition that increases the risk of about 80 health conditions. So all things considered, how many of us can say that we’re truly healthy, much less near optimal health?
Let’s continue to consider this statement. If you have “no known deficiencies, save your money.” Brody does sensibly state that vitamin D and vitamin B12 status are not hard to measure; if your doctor will approve the test, you might have to pay for it, but it can be done. That’s two of the essential nutrients. There are quite a few more, and many other non-essential yet important nutrients for which the government does not yet have an RDA. Lutein, for example, is non-essential yet important to eye health; your eyes have transporters to collect this nutrient from the bloodstream for good reason. So, is ignorance bliss? Would we be worrying over nothing? Not so, says the US government, in the form of its national nutrition survey, NHANES. Even if you simply consider a small subset of important nutrients, it is easy to show that the diets of the vast majority of Americans fall short. This state of affairs has resulted in both the US government and the WHO identifying “nutrients of concern.” Of concern why, if not for the effect poor nutrition has on health?
Brody cites the opinion of medical societies such as the AHA that a multivitamin cannot prevent heart disease. While it is very difficult to conduct the long-term, randomized controlled trials (RCT) of nutrients that might show such a benefit, it is comparatively easy to conduct an RCT on a prescription drug. There is no convincing evidence that statins work in primary prevention of cardiovascular disease. That does not stop the AHA and most doctors from recommending statins for just that purpose. Finessing an evidence-based medicine standard is apparently limited to expensive pharmaceuticals; essential nutrients must run the gauntlet laid out by a healthcare system centered around the treatment of disease via Rx medication.
Any suggestion that multivitamins are a waste of money should at minimum explicitly state that such advice does not extend to the prenatal period. Nutrient gaps during pregnancy can cause permanent harm to the baby. Unfortunately, not all supplements sold as prenatal vitamins in the US are worthy of the name. For example, many prenatal multis deliver less than 150 micrograms of iodine. Iodine deficiency is common, and can result in a permanent reduction in IQ of the child, in addition to the harm dealt to the mother. This is a matter that deserves more attention from the industry and the media.
A low point of her article was this statement: “….another major study [in 2013] linked fish oil supplements to a raised risk of prostate cancer….” This statement is misleading in so many ways that I hardly know where to begin. It might give one pause that the study cited did not examine fish oil supplement use! For a rather thorough critique of the study and of the press coverage that resulted, this analysis from the Mayo Clinic is instructive: http://www.mayoclinicproceedings.org/article/S0025-6196(13)01000-8/pdf
Americans as a whole are overfed and undernourished. We need more nutrients delivered in fewer calories; and those nutrients should be delivered without harmful levels of common contaminants such as heavy metals and pesticides. Yes, we should encourage wiser food choices, and a more responsible food and beverage industry. But let’s also recognize reality: quality supplements are a proven means to achieve the goal of improved nutrition, and consumption of supplements is obviously more likely to happen than for all Americans to suddenly consume more than 5 servings of veggies a day and give up all fast food and sodas. It is foolhardy that some health experts are so accepting of people consuming a handful of Rx drugs daily, while wringing their hands if those pills are dietary supplements instead. Brody acknowledges that she uses supplements herself. Americans are wise to do the same.
Bruce Daggy, Ph.D., FACN, SVP, R&D & Chief Science Officer, Shaklee Corporation